The Hidden Minority in the United States: A Study of Discrimination and Mental Health Among International Students during COVID-19 Pandemic

Background: Despite the disproportionate impact of COVID-19 and the precarious situation of US international students at the intersection of immigration policy and global education mobility, the unique experiences of the international student population in the light of pandemic othering and discrimination have been largely overlooked. Although evolving research shows the disparate impact of COVID-19 on college student's mental health, there is currently a dearth of literature exploring the pandemic-induced effects on the mental well-being of the US international student population. Further while the literature has established that perceived discrimination is significantly associated with mental health symptoms, the role of secondary stressors, such as loneliness in explaining the association between perceived discrimination and mental health, remains under-investigated. We aimed to fill this gap by proposing a mediation framework and estimating the mediating effects of loneliness and anxiety in the relationships between discrimination and depression in the international student population using a sub-sample of US international students (N=103) hailing from 38 countries.

Methods: Cross-sectional data was collected from July to August 2020 using a 50-item online survey instrument with three open-end questions from college students at least 18 years or older and enrolled at US universities. We used Patient Health Questionnaire-9, UCLA Loneliness Scale, Generalized Anxiety Disorder scale, and Everyday Discrimination Scale to measure depression, loneliness, anxiety and depression among international students, respectively. We also included open-ended questions on three domains: support received during COVID-19; support needed from university and programs to continue education and maintain overall well-being; and experiences during COVID-19. We conducted serial multiple mediation analysis using PROCESS Macro. To analyze the qualitative data, we used the three-step thematic analysis procedure: coding, sorting, and synthesizing.

Results: The multi-step mediation process showed significant direct effect of discrimination on loneliness (B =0.38, p < 0.001); significant direct effect of discrimination on anxiety (B =0.41, p > 0.001); the significant direct effect of loneliness on anxiety (B =0.26, p < 0.05); the significant direct effect of discrimination on depressive symptoms (B =0.20, p < 0.01); the significant direct effect of loneliness on depressive symptoms (B=0.27, p < 0.01); and the significant direct effect of anxiety on depressive symptoms (B=0.66, p < 0.001). Five overarching themes representing international student experiences and well-being during COVID-19 emerged from the open-ended questions: systematic apathy toward unique international student needs; in-between-ness: family space versus personal space; othering: experience with discrimination; COVID-19 and mental well-being, and COVID-19 prevention and self-responsibility.

Conclusion: The COVID-19 disruptions, lack of support from universities, unstable policy environment, and the increasing rise in racism, pandemic othering, and xenophobia have exacerbated the mental health needs of US international students. Our study provides a novel contribution in addressing the needs of an overlooked student population and understanding the pathways of discrimination and mental health for targeted research, practice, and policy implications. To the best of our knowledge, this is one of the first studies focused on the impact of COVID-19 on international students' mental health in the US.